Provider Demographics
NPI:1912924788
Name:JGGPO CORPORATION
Entity Type:Organization
Organization Name:JGGPO CORPORATION
Other - Org Name:MERCURY MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-566-6600
Mailing Address - Street 1:7806 GATEWAY BLVD E
Mailing Address - Street 2:STE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1800
Mailing Address - Country:US
Mailing Address - Phone:915-566-6600
Mailing Address - Fax:915-566-7682
Practice Address - Street 1:7806 GATEWAY BLVD E
Practice Address - Street 2:STE 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1800
Practice Address - Country:US
Practice Address - Phone:915-566-6600
Practice Address - Fax:915-566-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200103402Medicaid
TX200103401Medicaid
TX5703580001Medicare NSC